Monthly Archives: July 2014

Veterans aged 55 years or older with PTSD (post-traumatic stress disorder) appear to have a higher risk of developing dementia over a 7-year period, compared to individuals without PTSD, says a new report published in Archives of Psychiatry today, a JAMA/Archives journal.

PTSD occurs in a significant number of veterans returning from conflict areas or war zones, the article informs. Up to 17% of veterans coming home from Iraq and Afghanistan are thought to have PTSD, while 10% to 15% of Vietnam veterans had PTSD symptoms for at least 15 years after their return. Previous studies have linked PTSD to a wide variety of medical conditions in younger and middle-aged veterans, along with declines in thinking, learning and memory (cognitive performance).

Kristine Yaffe, M.D., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and team studied 181,093 veterans, aged 55 years and older (average age 68.8, 96.5% men) between 1997 and 2000. 53,155 of them had PTSD and 127,938 did not.

During a 7-year follow up (2000-2007), 17.2% (31,107) of the veterans developed dementia. Meaning:

A 10.6% risk of developing dementia for veterans with PTSD
A 6.6% risk of developing dementia for veterans without PTSD

Veterans with PTSD were still more likely to develop dementia when the analyses were adjusted for important differences, including demographic variables and other medical and psychiatric illnesses.

The authors wrote:

There are several reasons why patients with PTSD may have an increased risk of developing dementia.

PTSD may be a risk factor for dementia, or chronic stress may link the two conditions. Stress may harm the hippocampus, a brain area critical for memory and learning, or cause alterations in neurotransmitter and hormone levels that could hasten dementia.

The authors concluded:

The finding that PTSD is associated with a near doubling of the risk of dementia has important public health, policy and biological implications. It is important that those with PTSD are treated, and further investigation is needed to see whether successful treatment of PTSD may reduce the risk of adverse health outcomes, including dementia. In addition, it is critical to follow up patients with PTSD, especially if they are of an advanced age, to screen for cognitive impairment. Finally, mechanisms linking PTSD and dementia must be identified in hope of finding ways to improve the care and outcomes of patients with PTSD.

VCA Animal Hospitals announced that all VCA facilities located near the Ventura County Fillmore fire and the Riverside County Norco fire that have burned more than 10,000 acres in Southern California are offering free boarding for companion animals whose families have been evacuated or displaced from their homes as a result of the latest firestorms.

“As people’s homes are being threatened and they face evacuation to shelters, VCA is committed to assist them by providing free boarding for pets so they can focus on managing the critical issues with their families and homes,” said Art Antin, Chief Operating Officer of VCA Animal Hospitals. “We want everyone to know that they have this option to keep their pets safe during this difficult time.”

If you are a woman and work shifts your chances of enforced early retirement are greater than a woman who is not involved in shift-work or a man who works shifts, says an article in Occupational and Environmental Medicine.

The findings come from the Danish Work Environment Cohort Study, which started in 1990, and information from the national welfare register – it involved 8,000 male and female employees. Groups from the Cohort Study were formally interviewed about their place of work, work patterns, health and lifestyle.

The were all monitored until they were sixty years old – or until they died or emigrated (whichever occurred first).

253 (8.4%) of the 2,980 women who were included in the study had been forced to retire early because of ill health and had been granted disability pension by June 2006, compared to 173 (4.3%) of 4,025 men. The researchers report that the likelihood of women who do/did shift work requiring a disability pension is 34% greater than men, even after adjusting for factors likely to influence the results, such as lifestyle, including smoking, the workplace environment, and socioeconomic status.

Shift-work has been linked to a raised risk of heart attack, peptic ulcer, sleep disturbance, breast cancer, pregnancy complications, and accidents. However, this study did not look at the reasons for enforced early retirement.

The authors added that why women seem to be more vulnerable is not clear.

When treatment options dwindle or are exhausted, terminally ill-patients often opt for pain management and comfort over life-extending therapies. However, a team of researchers from Wake Forest University Baptist Medical Center, University of Rochester Medical Center and Unity Health System, report that a lack of thorough understanding about the laws governing end-of-life care may be leaving many medical providers with an ethical dilemma and causing some terminally-ill patients considerable, unnecessary pain.

The report, appearing in a recent issue of Mayo Clinic Proceedings, concerns the legal and ethical issues involved with deactivating an implantable cardioverter-defibrillator (ICD) in patients who are terminally-ill. The ICD is a small, battery-powered electrical impulse generator, much like a pacemaker, that is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. The device is programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity, which is often lifesaving. However, the legality of deactivating the ICD in terminally-ill patients who request to stop receiving the therapy is not clearly written, the study shows, and may be causing doctors to subject dying patients to undue pain.

The results stem from a physician survey that collected information about doctors’ knowledge and preferences regarding the medical, ethical and legal issues involved in caring for terminally-ill patients with an ICD.

In the brief, Vinodh Jeevanantham, M.D., of Wake Forest Baptist, and colleagues identify a general lack of knowledge among physicians concerning ICD therapy in terminally-ill patients that may result in extra suffering for them.

The ICD has become the most effective treatment for patients at high risk of life-threatening ventricular arrhythmias. It has been shown to improve survival, especially in elderly patients, by sensing changes in cardiac rhythm and delivering an electrical shock to the heart to restore normal rhythm.

Terminally-ill patients may be at increased risk of ICD shocks due to electrolyte disturbances, hypoxia and heart failure. It is estimated that more than 3 million people in North America are now eligible for an ICD. With a growing elderly population in the United States, clinicians are likely to care for an increasing number of elderly patients with ICDs.

The deactivation of an ICD, which may have been placed years before the onset of a terminal condition, may not be a clear-cut decision for patients, families, or physicians. Although physicians are aware that ICDs save lives by delivering an electrical shock and that such shocks are associated with considerable pain, busy clinicians may not always re-analyze the risk-benefit ratio of ICD therapy when their patient experiences a terminal illness, the report states. In this situation, life-prolonging therapy may no longer be desired. However, although guidelines for appropriate ICD use are readily available, a glaring deficiency exists regarding end-of-life care for patients with an ICD, according to the report, and the legality of deactivation is not clearly spelled out. There are also no clear-cut recommendations, Jeevanantham said.

Although voluntary refusal of treatment is a basic patient right, the study highlights a lack of clarity regarding the laws concerning ICD therapy in terminally-ill patients.

“While 64 of the physicians who participated in our survey had cared for terminally-ill patients with an ICD, they were unaware of any guidelines regarding deactivation of the device in such patients,” the authors wrote.

Of the 204 surveys distributed within Unity Health System between February and May 2007, 87 were returned. Among the physicians who responded, 64 reported experience caring for a patient with an ICD and terminal illness. Forty physicians either thought it was illegal or were not sure if it was legal to deactivate an ICD in these circumstances.

However, if the physicians were to be reassured about the legality of discontinuing ICD therapy, 79 of these same respondents said that they would be willing to discuss voluntary ICD deactivation with their dying patients. On the other hand, 16 of the physicians surveyed thought such action was either unethical or possibly unethical, and 19 physicians were uncomfortable deactivating an ICD in a terminally-ill patient, even though 51 of the doctors reported believing that an ICD-delivered shock would be painful for the patient.

“Although patients are better able to tolerate the shock from the ICD with time, they may still find an ICD firing frightening and painful,” the researchers stated in their report. “Our study showed that only 51 clinicians thought that the shock therapy would be uncomfortable. This finding highlights the importance of physician education regarding the ICD functioning, particularly symptoms that result from shock therapy.

“With increased knowledge about managing the withdrawal of this potentially life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an ICD.”

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Co-authors of the report were Saadia Sherazi, M.D., James P. Daubert, M.D., and Robert C. Block, M.D., all of University of Rochester Medical Center, and Khalid Abdel-Gadir, M.D., Michael R. DiSalle, M.D., James M. Haley, M.D., and Abrar H. Shah, M.D., all of Unity Health System, also in Rochester, N.Y.

Wake Forest University Baptist Medical Center (wfubmc.edu/) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children’s Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university’s School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of “America’s Best Hospitals” by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America’s Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.

Cystitis refers to inflammation of the lining of the bladder. It usually occurs when the normally sterile urethra and bladder (lower urinary tract) are infected by bacteria and become irritated and inflamed. Cystitis is fairly common and can affect both men and women and people of all ages. However, it is more common in women.
What causes cystitis?

When women insert a tampon there is a slight risk of bacteria entering via the urethra.
When a urinary catheter is changed there may be damage to the area.
There is a higher incidence of cystitis among women who use the diaphragm for contraception, compared to sexually active women who don’t.
The patient does not empty his/her bladder completely, creating an environment for bacteria to multiply in the bladder. This is fairly common among pregnant women, and also men whose prostates are enlarged.
Sexually active women have a higher risk of bacteria entering via the urethra.
Part of the urinary system may be blocked.
Other bladder or kidney problems.
Frequent and/or vigorous sex increases the chances of physical damage or bruising, which in turn makes the likelihood of cystitis developing higher.
During the menopause women produce less mucus in the vaginal area. This mucus stops the bacteria from multiplying. Women on HRT (hormone replacement therapy) have a lower risk of developing cystitis compared to menopausal women not on HRT.
During the menopause the lining of a woman’s urethra gets thinner as her levels of estrogen drop. The thinner the lining becomes, the higher the chances are of infection and damage.
A woman’s urethra opening is much nearer the anus than a man’s. Consequently, there is a higher risk of bacteria entering the urethra from the anus.

Experts say that the majority of women will have at least one incidence of cystitis during their lives. A sizeable number have more than one incidence. Doctors say a woman should see her GP (general practitioner, primary care physician) when she gets cystitis for the first time, as should any woman who has cystitis three or more times within a twelve-month period.

All men and children should see their doctor if they have cystitis.

When men get cystitis it tends to be potentially more serious than when women get it. Male cystitis is more likely to be caused by some other serious underlying condition, such as a prostate infection, cancer, an obstruction, or an enlarged prostate. In most cases of male cystitis early treatment is effective and the problem is solved. However, untreated male bladder infection can lead to kidney or prostate infections and/or damage. Men who have sex with men are more likely to have cystitis than other men.
What are the symptoms of cystitis?

Urine may have traces of blood
Urine is dark and/or cloudy
Urine has a strong smell
Pain just above the pubic bone
Pain in the lower back
Pain in the abdomen
Only small amount of urine is passed each time
Frequent need to urinate
Burning sensation when urinating
Older women may feel weak and feverish but have none of the other symptoms mentioned above
When children have cystitis they may have any of the symptoms listed above, plus vomiting and general weakness.

Other illnesses or conditions may have the same symptoms as cystitis. They include:

How is cystitis diagnosed?
A doctor will ask the patient some questions, carry out an examination, and do a urine test. The urine test will either be sent to a laboratory, or the GP may use a dipstick. A “clean catch” (urine culture) or catheterized urine specimen may be performed to determine the type of bacteria in the urine. After finding out which specific bacterium is causing the infection the patient will be prescribed an oral antibiotic.

Most GPs in the UK will also offer to find out whether the patient might have a Sexually Transmitted Infection (STI). STIs often have similar symptoms to cystitis.

Patients who get cystitis regularly may need further tests. This could include an ultrasound scan, an X-ray, or a cytoscopy (a fiber optic camera examination) of the bladder.
What is the treatment for cystitis?
In the vast majority of cases, mild cystitis will resolve itself within a few days. Any cystitis that lasts more than about four days should be consulted with your GP.

Sometimes a short 3-day course of antibiotics is given. Most patients will experience the beneficial effects of an antibiotic within the first day of treatment. If symptoms do not improve after taking the antibiotics the patient should return to her/his doctor. The following antibiotics are commonly used for cystitis: Nitrofurantoin, Trimethoprim-sulfamethoxazole, Amoxicillin, Cephalosporins, Ciprofloxacin or levofloxacin, and Doxycycline.

Elderly people, and those with possible weakened immune systems, such as people with diabetes, have a higher risk of the infection spreading to the kidney, as well as other complications. Vulnerable people should be treated promptly.

The following home remedies and measures may help:

Painkillers, such as paracetamol (Tylenol) or ibuprofen may help with the discomfort. If you are pregnant discuss this with either your doctor or a well-qualified pharmacist.
Drink plenty of fluids. This will help flush the bacteria from the system.
Do not consume alcohol.
Sodium citrate or potassium citrate in sachets or solutions sometimes ease symptoms.
Cranberry juice has been shown to be good for the urinary tract. Drinking some cranberry juice each day may prevent recurrences – some people have even experienced relief of symptoms. Cranberry juice also has condensed tannins, Manoose – D and proanthocyanidins which have been found to inhibit the activity of E. coli by preventing the bacteria from sticking to mucosal surfaces lining the bladder and gut, helping to clear bacteria from the urinary tract.
Refrain from sex while you are infected.

Cystitis prevention
Many cases of cystitis are not preventable. However, the following measures may help:

Practice good hygiene after sex, especially women. Try using neutral soaps around the genitals, not perfumed ones.
When you urinate try to make sure you have emptied your bladder completely.
If you feel you need to urinate go straight away – do not postpone it.
Avoid tight underwear, and tight pants (trousers).
Wear cotton underwear.
Wipe from front to back.
When having sex make sure sexual organ is lubricated, if necessary use a lubricant.
Empty bladder as soon as possible after sex.
If you wear a catheter ask your doctor or nurse how to avoid damage when you have to change it.

A new study on the use of prostate-specific antigen (PSA)-based prostate cancer screening in the United States found that many elderly men may be undergoing unnecessary prostate cancer screenings. Using data from surveys conducted in 2000 and 2005, researchers report that nearly half of men in their seventies underwent PSA screening in the past year almost double the screening rate of men in their early fifties, who are more likely to benefit from early prostate cancer diagnosis and treatment. Further, men aged 85 and older were screened just as often as men in their early fifties.

Because prostate cancer tends to be slow-growing, data show that many men particularly those in their seventies and older will die of other causes before prostate cancer becomes a problem that requires medical attention. The new findings underscore a long-standing concern that overuse of PSA screening and PSA-based treatment decisions may lead to unnecessary treatment of many older men and potential complications such as incontinence, impotence and bowel dysfunction.

“Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We’re concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefitting the patient and paradoxically can cause more harm than good,” said senior author Scott Eggener, MD, assistant professor of surgery at the University of Chicago. “We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year. These results emphasize the need for greater physician interaction and conversations about the merits and limitations of prostate cancer screening for men of all ages.”

While large declines in prostate cancer metastases and death rates in the last 20 years coincide with widespread use of PSA-based screening, questions remain about its use. Data have been unclear about when men should be considered for PSA screening and when screening should stop, and recent studies have provided conflicting evidence on whether routine PSA screening in the general population of men actually reduces the risk of dying from prostate cancer. Based on these concerns, major organizations such as the American Cancer Society now encourage men who expect to live at least 10 years to talk with their doctor about the risks and benefits of screening, starting at age 50 for men with an average risk or at age 45 for men with a higher risk.

In this study, the researchers examined results from health surveys of randomly selected households conducted in 2000 and 2005 as part of the federal government-sponsored National Health Interview Survey. In addition to reviewing survey data, which included information on age, smoking, mass-body index, underlying medical conditions and other factors, the investigators calculated the estimated five-year life expectancy of each man over 40 who had received a PSA test.

They divided survey results of men age 70 and older into five-year age groups (70 to 74, 75 to 79, 80 to 84, and 85 years and older). In all, 2,623 men ages 70 and older were included in the analysis, while nearly 12,000 men between the ages of 40 and 69 served as controls.

The overall PSA screening rate within the past year for men aged 40 and older was 23.7 percent in 2000 and 26.0 percent in 2005. The PSA screening rate was lowest in the 40 to 44 age group (7.5 percent). Researchers found that the PSA screening rate was 24.0 percent in men ages 50 to 54, increasing with age until a peak of 45.5 percent in ages 70 to 74. Screening rates then declined with age, with 24.6 percent of men 85 or older reporting being screened.

Among men who were 70 or older, the investigators did find that PSA screening was more common in men with a greater estimated five-year life expectancy. For example, approximately 47.3 percent of men who were unlikely to die in five years (an estimated chance of 15 percent or less) were screened, 39.2 percent of men with an intermediate chance (16 to 48 percent probability) of dying received screening, and 30.7 percent of those with the highest probability of death (48 percent or greater) in five years were screened.

Eggener offered some possible explanations for the results, noting that screening rates may reflect how frequently men visit primary care physicians. Older men tend to have more health problems that require doctor visits, and this may in turn result in more frequent PSA testing than younger men, who see their doctors less. The authors suggest that physicians should be more selective in recommending PSA testing for older men, particularly those with a limited life expectancy, and consider more routinely screening younger, healthier men who are most likely to benefit from early prostate cancer diagnosis and related treatment. Men are encouraged to talk with their doctor about their individual risk for prostate cancer, and about the risks and benefits of prostate cancer screening.

Canada’s Environment Minister, John Baird, took action at the United Nations Climate Change Conference in Indonesia. Canada will invest $85.9 million over four years to help Canadians respond to climate change. Minister Baird was joined at the announcement by Mary Simon, President of Inuit Tapiriit Kanatami (ITK) and one of Canada’s Eminent Advisors to the Minister.

“Canada is leading by example and stepping up its fight against climate change by taking concrete steps to help Canadians adapt to our changing climate,” said Minister Baird. “With our Turning the Corner Action Plan to Reduce Greenhouse Gases and Air Pollution, Canada started taking real action on climate change. However, the science is clear. Even the most ambitious efforts on fighting climate change cannot prevent the warming that is expected to continue in the short term. That’s why we’re providing support to address this challenge head on.”

Canada will spend:

- $15 million for research to improve climate change scenarios;
- $14 million for a program to assist Northerners in assessing key vulnerabilities and opportunities for adaptation;
- $7 million for climate change and health adaptation in northern / Inuit communities;
- $14.9 million to develop a pilot climate and infectious disease alert and response system to protect the health of Canadians from the impacts associated with a changing climate; and
- $35 million for risk management tools for adaptation and to support the development and implementation of regional programs.

“Canadians want action now on climate change — and that’s exactly what we’re doing,” said the Honourable Gary Lunn, Minister of Natural Resources. “My department is using its recognized expertise in adaptation and resource management to create tools and methodologies that will help address the impacts of climate change.”

“Our Government is keenly aware of the important link between health and the environment, and as Health Minister I see today’s funding announcements as very positive news for Canadians concerned about the health effects of the air they breathe and the water they drink,”said Minister of Health Tony Clement. “Additionally, the new infectious disease alert and response system will enable us to monitor and act quickly particularly in vulnerable areas such as Canada’s north.”

President Bush on Wednesday as expected vetoed the Stem Cell Research Enhancement Act of 2005 (HR 810), which would have expanded federal funding for human embryonic stem cell research, the Boston Globe reports (Klein, Boston Globe, 7/20). Shortly after the veto, the first in Bush’s presidency, the House voted 235-193 to try to override the veto but was 51 votes short of the two-thirds majority needed (Hook, Los Angeles Times, 7/20). Bush on Aug. 9, 2001, announced a policy that allows federal funding for embryonic stem cell research only when it uses stem cell lines created on or before that date. The bill would have allowed funding for research using stem cells derived from embryos originally created for fertility treatments and willingly donated by patients (Kaiser Daily Women’s Health Policy Report, 7/19). Bush during a White House ceremony said, “This bill would support the taking of innocent human life in the hope of finding medical benefits for others. It crosses a moral boundary that our decent society needs to respect, so I vetoed it.” He added, “If this bill would have become law, American taxpayers would, for the first time in our history, be compelled to fund the deliberate destruction of human embryos. And I’m not going to allow it” (Epstein, San Francisco Chronicle, 7/20). About 200 supporters of Bush’s decision to veto the bill were in attendance during his remarks (Benedetto/Stone, USA Today, 7/20). Twenty-three children who were born as the result of embryos “adopted” from fertility clinics were present in the audience, according to the Denver Post (Mulkern/Soraghan, Denver Post, 7/20). “These boys and girls are not spare parts,” Bush said, adding, “They remind us of what is lost when embryos are destroyed in the name of research.”

Override Vote, Electoral Implications Fifty-one Republicans, 183 Democrats and one independent in the House voted to override Bush’s veto, while 179 Republicans and four Democrats voted to sustain the veto (Stolberg, New York Times, 7/20). Three House members changed their vote from the 238-194 vote the chamber took to pass the bill last year, CQ Today reports. Reps. Dave Reichert (R-Wash.) and Curt Weldon (R-Pa.) voted against the Stem Cell Research Enhancement Act last year but voted to override Bush’s veto on Wednesday. Rep. C.W. Bill Young (R-Fla.) voted for the measure last year but voted to sustain the veto. Rep. Diana DeGette (D-Colo.), co-sponsor of the legislation, said she has “no doubt that in 30 months when we have a new president,” Bush’s 2001 executive order on embryonic stem cell research will be changed (Ferrechio/Crowley, CQ Today, 7/19). She added that she aims this year to attach provisions of the bill to appropriations measures (Sprengelmeyer, Denver Rocky Mountain News, 7/20). Rep. Mike Castle (R-Del.), co-sponsor of the bill, and other lawmakers also are looking at attaching the bill to other measures or bringing it up next year. “I’m energized by this, not quieted,” Castle said, adding, “You’re going to have embryonic stem cell research funded by the United States government” (Brooks, Wilmington News Journal, 7/20). According to the Wall Street Journal, Democrats said they plan to bring up stem cell research in campaigns for the November election, including in Missouri, Montana, Ohio and Pennsylvania, where incumbent Republicans voted against the measure (Lueck, Wall Street Journal, 7/20).

Bush Signs Bill Banning ‘Fetal Farms’ Bush on Wednesday signed into law a bill (S 3504) that would make it illegal to conduct research on embryos from “fetal farms,” the Washington Post reports (Babington, Washington Post, 7/20). In fetal farms, human embryos could be made in a nonhuman uterus or from human pregnancies that were created specifically for the purpose of research (Kaiser Daily Women’s Health Policy Report, 7/19). “This good law prohibits one of the most egregious abuses in biomedical research, the trafficking in human fetuses that are created with the sole intent of aborting them to harvest their parts,” Bush said, adding, “Human beings are not a raw material to be exploited, or a commodity to be bought or sold, and this bill will help ensure that we respect the fundamental ethical line.” Bush also said he was “disappointed” that the House has not yet approved a Senate-passed bill (S 2754) that would require NIH to research and fund methods of creating embryonic stem cell lines without destroying human embryos (White House release, 7/19). The bill also contains a rule that the measure would not affect any regulations regarding embryonic stem cells, human cloning or any other research methods that currently are prohibited and calls for research on adult stem cells. The House on Tuesday — shortly after the bill was approved by the Senate — voted 273-154 to approve the measure, which was not enough to pass the House under suspended House rules (Kaiser Daily Women’s Health Policy Report, 7/19). Castle said the bill was “wholly unnecessary, an obvious politically structured bill created to allow people who oppose (the embryonic stem cell bill) to say that they support stem cell research” (Wilmington News Journal, 7/20).

3D CT scans provide a more comprehensive view of complex varicose veins (one of the most common diseases in the world) in the lower extremities, according to a study performed at the Seoul National University Hospital in Seoul, Republic of Korea. This technique aids surgeons to more effectively treat varicose veins.

One hundred patients with varicose veins in their lower extremities underwent 3D CT scans and “images attained were excellent in 76% of patients,” said Jin Wook Chung, MD, and Whal Lee, MD, lead authors of the study. 3D CT scans also gave doctors a closer look at the great saphenous vein (the large superficial vein of the leg and thigh) in 99.5% of all lower extremities being examined.

Varicose veins sit deeply inside fat and 3-D CT allows doctors to have an overview of them. With 3D CT, “the patient and surgeon have a more comprehensive way to see the disease. It shows all aspects of the varicose veins that are important to detect before surgery to prevent recurrence,” according to Drs. Chung and Lee.

“3-D CT makes it easy to understand the disease and make a surgical plan,” said Drs. Chung and Lee.

This study appears in the October issue of the American Journal of Roentgenology. For a copy of the full study, please contact Heather Curry via email at hcurryarrs.

Click here for the abstract
About ARRS

The American Roentgen Ray Society (ARRS) was founded in 1900 and is the oldest radiology society in the United States. Its monthly journal, the American Journal of Roentgenology, began publication in 1906. Radiologists from all over the world attend the ARRS annual meeting to participate in instructional courses, scientific paper presentations and scientific and commercial exhibits related to the field of radiology. The Society is named after the first Nobel Laureate in Physics, Wilhelm RГ¶entgen, who discovered the x-ray in 1895.

The second wave of the pandemic (H1N1) was substantially greater than the first with 4.8 times more hospital admissions, 4.6 times more deaths and 4 times more ICU cases, according to a study published in CMAJ (Canadian Medical Association Journal) . However, because of the larger number of people hospitalized during the second wave compared to the first, the percentage of people with severe outcomes was smaller.

The researchers compared demographic and clinical characteristics as well as outcomes of patients with (H1N1) influenza admitted to hospital during the first wave with those admitted during the second wave and post-peak period of the pandemic.

In the first wave, Nunavut, Manitoba and Quebec had the highest rates for hospital admissions. In the second wave, all provinces and territories were affected with the Maritimes provinces, Alberta, British Columbia, the Yukon Territory and the Northwest Territories experiencing much higher rates of hospital admission than in the first one. Quebec and Ontario were impacted in both waves, with Quebec reporting the highest number of hospitalizations and Ontario reported the most deaths overall.

At the height of the first wave (May 31 to June 20, 2009), 9.4% of hospital admissions, 10.1% of ICU admissions and 10% of deaths occurred. At the height of the second wave (October 25 to November 14, 2009), 51% of overall hospital admissions, 49.4% of ICU admissions and 53% of deaths occurred.

ICU admissions and deaths as a percentage of hospitalizations went down in the second wave.

“The second wave was substantially larger and, although the patients admitted to hospital were older and more of them had underlying conditions, a smaller proportion had a severe outcome,” writes Melissa Helferty, Public Health Agency of Canada and coauthors. “The differences are thought to be due mainly to public health and clinical interventions implemented between the first and second waves.”

“A national seroprevalence survey at the end of the first wave would have allowed us to better qualify the severity of the cases in Canada and permitted a more accurate comparison with other countries,” conclude the authors.